الفهرس 
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Abstract
Introduction:
Chronic kidney disease (CKD) is the most common cause of end stage kidney failure worldwide in developing countries like Egypt, there is an increase in the incidence and prevalence of End Stage Renal Disease (ESRD) represents a great burden on health system. The prevalence of ESRD in Egypt raise from 225 per million populations (pmp) in 1996 to 483 pmp in 2004. Recently in Egypt, the estimated number of patients with ESRD almost doubled, from 18,000 in year 2000 to 33,693 in 2009 (Hassona, et al., 2012). Low prevalence in Egypt may be due to lack of registration and documentation programs for ESRD patients and also due to short life expectancy for these patients (El-Arbagy et al., 2015).
When the kidney loses the majority of its function and glomerular filtration rate (GFR) become less than 15%; the patient is diagnosed as ESRD, once diagnosed with ESRD, patient needs to undergo renal replacement therapy (RRT) as a life - saving treatment (United states Renal Data System.,2014).
Hemodialysis is a process by which blood is removed from the body and circulated through an artificial kidney to temporarily clear the body from harmful wastes and extra fluids. Then, the filtered blood is returned to the patient again. During the treatment, the blood moves through tubes into the dialyzer which filters out wastes and extra water. Then the filtered blood flows through another set of tubes back into the body (Sreenivasulu, Dasari., 2017).
Patients requiring long-term hemodialysis are often concerned about the unpredictability of the illness and the disruption of their lives. They often have financial problems, difficulty holding a job, waning sexual desire and impotence, depression from being chronically ill and fear of dying. Younger patients worry about marriage, having children, and the burden that they bring to their families. The regimented life style that frequent dialysis treatments and restrictions in food and fluid intake impose is often demoralizing to the patient and family (Hoshino, 2021).
In recent years, efforts to enhance QoL in hemodialysis patients as one of the important aims of treatment in ESD have encouraged health care providers to undertake more research to identify different dimensions of QoL and effective ways to improve these. Nurses are important members of the health care team and have a significant role in caring for patients with hemodialysis, in particular in identifying the needs of patients and their families. Limiting complications of the disease and improving quality of life. The quality of life is of central concern in any evaluative research. Improved QoL is probably the most desirable outcome of all health care policies (Peters et al., 2018).
The role of the nurse in caring of hemodialysis patients can be divided into general care, educator and facilitator and counselor (Ran and Hyde, 2018). The role of the nurse in general care of hemodialysis patients can be classified according to the stage of dialysis. At all these stages, monitoring the physical status of the patient is central to detect any abnormal changes, to ensure comfort, and to help the patient to adjust to the care and changes in life-style (Morfin, et al., 2016).
The aim of this study
The study aims to assess quality of life among patients with hemodialysis at Dialysis unit at Menoufia university hospital affiliated to Menoufia University.
Research question
1. What are the levels of quality of life among patients with hemodialysis?
2. What is the quality of life among hemodialysis patients?
Research design:
A descriptive study design has been used to conduct this study.
Settings:
This study was conducted in hemodialysis unit at Menoufia university hospital affiliated to Menoufia city.
Subjects
The subjects of the present study included A convenient sample of all available patients (N= 60) having hemodialysis who are attending the previously mentioned setting during 3 months and are willing to participate in this study.
Tools and techniques of data collection.
Data were collected through using of the following tools:
Tool 1: A structured interview questionnaire sheet for patients (Appendix I)
It was developed by the researcher in Arabic language after reviewing the related literature. It is comprised of two parts as follows:
• Part (1): Concerned with the socio-demographic characteristics of the studied patients such as age, sex, and level of education.
• Part (2): Concerned with clinical data of the studied patients such as duration of illness, previous hospitalization and number of hospitalizations.
Tool 2: Kidney Disease Quality of Life Scale Short Form36 (KDQOL-SF36) version 1.3 (Arabic version). (Appendix II)
Scoring system for Kidney Disease Quality of Life Scale Short Form (KDQOL-SF36):
The standard scoring program of the KDQOL-SFTM 1.3 is based on the Microsoft Excel 97 spreadsheet program and includes information about the computation method. The scores for each dimension range from 0 to 100, with higher scores reflecting better HRQOL.
The results of the study can be summarized as follows:
• 45% of studied patients were in the age group from 50 to less than 60 years of age.
• In relation to sex; 73.3% of studied patients were male. Concerning patient residence, more than half were in rural.
• 90% of studied patients were diagnosed as CRF and more than two fifth (45%) of them were diagnosed from more than three and up to six years.
• The majority of studied patient (83.3%) have 3 times per week and the 81.7 of them have dialysis through fistula.
• More than half (51.7%) of studied patients reported high physical functioning.
• Less than two thirds (65%) of studied patients reported high fatigue level.
• More than half (51.7%) of studied patients have high role physical levels.
• (63.3%) of studied patient have high pain levels
• More than half (58%) of studied patients have high levels of emotional wellbeing.
• The majority (80%) reported high levels of social functioning.
• 68.3% of studied patient have low quality of life.
• There was a highly statically significant relation between gender and occupation of studied patients and their total quality of life at (P=.009& .002, respectively)
• There was a highly statically significant relation between studied patients’ clinical variables (previous hospitalization, time since starting dialysis, weekly dialysis time and dialysis session duration) and their total quality of life at (P= .002, .045, .001 & .003 respectively).
Conclusion
Based on the finding of the current study, it was concluded that, the factors affecting QoL for patients on regular hemodialysis were gender and occupation. Moreover; there was strong positive association between total quality of life of studied patient and their role physical, role emotional, social well-being and energy level at (P=.000, .000, .048 & .002 respectively).
Recommendations:
In the light of the findings of the current study, the following recommendations are suggested:
1. Apply this research on a larger number of patients, to identify and evaluate more other factors not analyzed in this study which may affecting QoL for patients with ESRD such as: coping behaviors, quality of care received.
2. Designing an intervention for CKD patients to improve their QoL and to measure the health change for that patient to ensure that the intervention will be helpful.
3. Train nurses working with hemodialysis to acquire the skills of listening to patients problems and comfort them, providing physical and psychological support to the patients.